Introduction
Screening of high risk cases
High risk cases (according to WHO)
Management of high risk cases
Risk approach (according to WHO)
Interventions to reduce maternal mortality
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
Every woman should be thinking about her health whether or not she is planning pregnancy. One reason is that about half of all pregnancies are not planned. Unplanned pregnancies are at greater risk of preterm birth and low birth weight babies. Another reason is that, despite important advances in medicine and prenatal care, about 1 in 8 babies is born too early. Researchers are trying to find out why and how to prevent preterm birth. But experts agree that women need to be healthier before becoming pregnant. By taking action on health issues and risks before pregnancy, you can prevent problems that might affect you or your baby later.
Introduction
Screening of high risk cases
High risk cases (according to WHO)
Management of high risk cases
Risk approach (according to WHO)
Interventions to reduce maternal mortality
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
Every woman should be thinking about her health whether or not she is planning pregnancy. One reason is that about half of all pregnancies are not planned. Unplanned pregnancies are at greater risk of preterm birth and low birth weight babies. Another reason is that, despite important advances in medicine and prenatal care, about 1 in 8 babies is born too early. Researchers are trying to find out why and how to prevent preterm birth. But experts agree that women need to be healthier before becoming pregnant. By taking action on health issues and risks before pregnancy, you can prevent problems that might affect you or your baby later.
Discover the essential steps and expert advice for optimal pre-conception care. Learn how to enhance your fertility, ensure a healthy pregnancy, and lay the foundation for your baby's lifelong well-being
Patient information to complete the Soap Note. See attachment .docxssuser562afc1
Patient information to complete the Soap Note. See attachment
Family Medicine 12: 16-year-old female with vaginal bleeding and UCG
User:
Beatriz Duque
Email:
[email protected]
Date:
August 28, 2020 8:38PM
Learning Objectives
The student should be able to:
Describe the essential features of a preconception consultation, including how to incorporate this content into any visit.
Discuss chlamydia screening.
Demonstrate the use of the HEEADSS adolescent-interviewing technique.
Recognize pregnancy: intrauterine, ectopic, and miscarriage.
Discuss options during an unplanned pregnancy.
Select initial prenatal labs.
Counsel a pregnant patient for healthy behavior, folic acid supplementation, and immunizations.
Outline normal progression of symptoms and physical exam findings during pregnancy.
Demonstrate the management of a miscarriage, including the medical and social follow-up.
Knowledge
Chlamydia: Epidemiology, Course of Disease, and Screening Recommendations
Epidemiology
Chlamydial infection is the most common sexually transmitted bacterial infection in the United States. In 2007, more than 1.1 million chlamydia cases were reported to the CDC. It is thought that another million cases of chlamydia remain unreported.
Course of disease
Chlamydia is often insidious and asymptomatic. In women, genital chlamydial infection may result in urethritis, cervicitis, pelvic inflammatory disease (PID), infertility, ectopic pregnancy, and chronic pelvic pain. Chlamydial infection during pregnancy is related to adverse pregnancy outcomes, including miscarriage, premature rupture of membranes, preterm labor, low birth weight, and infant mortality.
Screening recommendations
The USPSTF found fair evidence that nucleic acid amplification tests (NAATs) can identify chlamydial infection in asymptomatic men and women, including asymptomatic pregnant women, with high test specificity. In low prevalence populations, however, a positive test is more likely to be a false positive than a true positive, even with the most accurate tests available.
Qualities of a Good Screening Test
1. The condition should be an important health problem and the condition screened for must have a high prevalence in the population.
2. There should be a latent stage of the disease.
3. There should also be effective treatment for the condition being screened.
4. Facilities for diagnosis and treatment should be available.
5. There should be a test or examination for the condition.
6. The test should be acceptable to the population and the total cost of finding a case should be economically balanced in relation to medical expenditure as a whole. The potential benefits of early detection and treatment of a condition need to be weighed against many factors, including adverse side effects of the screening test, time and effort required (of both the patient and the health care system) to take the test, financial cost of the test, potential psychological and phys.
Preventive pediatrics in Child Health NursingDhara Vyas
Preventive pediatrics has been defined as the prevention of diseases and the promotion of physical, mental, and social well-being for children to reach optimal growth and development.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
1. PRE-CONCEPTION CARE AND COUNSELING
INTRODUCTION
Concept of preconception care has evolved over the last several decades
J.W. Ballantyne - originated concept of prenatal care
Preconception and prenatal care are forms of primary care and prevention
Opportunities exist in many settings
Should target all women of reproductive age
Education and preparation are key
Worldwide maternal mortality approaches one million women annually
Risk of maternal death in the is 1 in 10,000 live births
Unintended pregnancy rate approaches 40% annually
COMPONENTS OF PRECONCEPTION CARE
Risk assessment
Education
Intervention or modification
Counseling
GOALS OF PRECONCEPTION CARE
To identify pre-existing conditions that may affect an anticipated pregnancy
This may allow for intervention(s) that could lead to more favorable outcome
Goal should be realistic
Identification process involves mother and fetus
CONTRACEPTION
Good preconception care begins with appropriate contraception!!
Should be addressed at each visit, including primary care visits, emergency room
visits, and well woman appointments
Should be appropriate as regards patient’s lifestyle and medical condition
2. MATERNAL RISK ASSESSMENT
Family and genetic history (maternal and paternal)
Medical history
Medication use
Environmental exposures (home and work)
Obstetric and reproductive history
Domestic abuse
Emotional preparedness
Infectious disease
HIV
Immunization history
Sexually transmitted diseases
REPRODUCTIVE HISTORY
Conditions with recurrence risk:
Premature delivery
Preeclampsia/eclampsia
Placenta previa/abruption
Gestational diabetes
Preterm premature rupture of membranes
Certain birth defects/genetic disorders
Prior uterine surgery or anomalies
Good time to discuss trial of labor
Prior pregnancy losses
Habitual abortion
Must also deal with associated emotional issues
FAMILY HISTORY
Coagulation disorders
Mental retardation
Other conditions (congenital adrenal hyperplasia, neurofibromatosis, inborn errors of
metabolism)
3. Anueploidy Risk
Risk of any type of aneuploidy increases with maternal age
Offer genetics consultation
Important to obtain family pedigree
Risk increases with increasing maternal age
Risk of Trisomy 21 at age 35 is 1/378 and that of all aneuploidy is 1/192
Risk increases to 1/30 and 1/21 respectively, at age 45
Risk with increased paternal age probably small
RISK ASSESSMENT - MEDICAL HISTORY
Possible effects of pregnancy on disease
Possible effects of disease on pregnancy, mother and fetus
Evaluate for any possible interventions
Assess for possibility of teratogenic effects of medications
Evaluate for presence of microvascular disease and level of glucose control
Frequency of malformations 6-10 %
Periconceptual control can significantly decrease malformation rate
Hemoglobin A1C crude marker of glucose control/ ? Association with anomaly rate
Hypertension - assess for microvascular disease, severity, underlying etiology
Hyperthyroidism
Hypothyroidism
Previous treatment for cancer
History of organ transplantation
RISK ASSESSMENT - MEDICAL HISTORY
Connective tissue disorder
Inflammatory bowel disease
Asthma
Neurological and psychiatric disorders
SPECIAL RISKS
Primary Pulmonary Hypertension
4. Chronic Renal Disease
Complicated coarctation of the aorta
Sever mitral or aortic stenosis
Vasculitis syndromes
RISK ASSESSMENT - IMMUNIZATIONS
Rubella - should wait 3 months before conceiving
Hepatitis B
Tetanus
Mantoux skin test
Influenza, pneumovax as indicated
Varicella
RISK ASSESSMENT - STD’S
Assess for high risk behaviors and counsel appropriately
HIV - treatment can decrease transmission to fetus from 30% to 8%
Gonorrhea
Chlamydia
Trichomonas
Bacterial Vaginosis - presence associated with increased risk of premature labor and
delivery
Group B beta streptococcus - ?
HPV - human papillomavirus/PAP/possible colposcopy in select cases/neonatal
infection possible
HSV - as indicated
congenital syphilis can occur at any stage of maternal disease
Toxoplasmosis - cat owners or if handle raw meat
Cytomegalovirus
SOCIAL HISTORY
Illicit substance use and abuse major public health problem
Alcohol
Most common preventable cause of mental retardation
5. No proven safe level of ingestion
Tobacco use
Associated with numerous pregnancy complications
One of most common preventable cause of fetal growth restriction
Increased risk of other health problems
Illicit drug use
Usually associated with other high risk behaviors
Possible teratogen
Increased pregnancy complications
Associated with sudden death, infarction, hypertension
Prescription drug dependency
Evaluate for life stressors that may predispose to substance abuse
Encourage counseling and rehabilitation prior to pregnancy
May have co-existing psychological disorders
Seen in all social classes
DOMESTIC VIOLENCE
Incidence of abuse increases during pregnancy
Physicians do a poor job of screening
Look for: vague complaints; substance abuse; insomnia; injuries to central body areas;
multiple ER visits
Develop emergency plan/referral numbers
TERATOGENS
Evaluate home environment
Work exposure (plastics, vinyl monomers, heavy metals, viral agents)
Medication or drug use
Alcohol - fetal alcohol syndrome
ACE - inhibitors - fetal renal dysfunction
Coumarin derivatives - effects seen in up to 25% exposed
Tegretol - craniofacial abnormalities; limb defects; growth and mental retardation
Dilantin - fetal hydantoin syndrome
Valproic acid - neural tube defects (1-2%)
Lithium – congenital anomaly
Tetracycline - deposition in fetal long bones
6. Vitamin A derivatives - associated with numerous severe defects;
X-Rays/radioactive isotopes
DES - reproductive tract abnormalities
Folic acid antagonists
Thalidomide - limb defects
Should consult specialist, poison control center or teratogen centers
Some medications have different safety periods between cessation and conception
NUTRITIONAL ASSESSMENT
Assess optimal nutritional needs
Risk factors
Low income
Substance abuse
Fad dieting/vegans
Depression/mental illness
Gastrointestinal disease
Chronic disorders
Must also assess for existence of eating disorders
Folic acid supplementation beginning one month prior to conception can greatly
reduce incidence of neural tube defects
Utilize nutritionist for full evaluation
Obesity
Adolescence
Pre-existing conditions - iron deficiency anemia, hyperlipidemia
Evaluate exercise regimen
FINANCIAL AND EMOTIONAL CONCERNS
Couples should be aware of maternity coverage provided by their insurance
Leave benefits
Stress importance of good family support
May consult social services
Emotional issues addressed
7. SUMMARY
Thorough history taking
Complete physical exam
Necessary consultations
Counseling
Instruct on accurate menstrual history and on contraception
Necessary laboratory evaluation
Adequate preconception counseling can decrease risk of pregnancy complications
Education can lead to healthy habits and realistic expectations
Can lead to more efficient and less costly pregnancy care
REFERENCES
1. Adams EM, Bruce C, Shulman MS et al: The PRAMS Working Group: pregnancy
planning and preconception counseling. Obstet Gynecol 82:955, 1993.
2. Moos MK, Cefalo RC: Preconceptional health promotion : A focus for obstetric
care. Am J Perinatol 4:63, 1987.
3. MRC Vitamin Study research Group : Prevention of neural tube defects: results of the
Medical Research Council Vitamin Study. Lancet 338:131, 1991.
4. Resources: Reproductive Toxicology Center; Obstetrical textbooks